What Is CRE? The "Nightmare" Superbug Is Reportedly Drug-Resistant

Sometimes the scariest things can be invisible. That is
certainly the case with CRE,
a “nightmare” superbug that is reportedly drug-resistant. On Thursday, the
U.S. Department of Defense announced that the first known case of a carbapenem-resistant
Enterobacteriaceae (CRE) infection had hit the United States, and everyone started panicking.

The infection is rare, according to Dr. Tom Frieden,
director of Centers for Disease Control and Prevention who announced the case
at the National Press Club in Washington D.C. Nevertheless, he called it “a
nightmare bacteria” in an interview with The Washington Post. CRE, a strain of E. coli, is seemingly resistant to all known antibiotics
including Colistin, which often serves as a last resort when all other antibiotics
fail.

A 49-year-old woman’s urine tested positive for CRE last
month. She had not traveled outside the United States within the past five
months. There are no more details available about the case including how the
patient contracted the infection in the first place.

CRE is spread through contact with an infected person, particularly contact with a cut or stool. The bug is more likely to infect patients in acute and longterm healthcare facilities than healthy individuals. Those who are already ill or with weakened immune system are also more at risk.

The symptoms of CRE vary based on where the infection is located (i.e. if CRE infects your urinary tract, you will have symptoms of a urinary tract infection).

This is the first case seen in the United States but the
antibiotic-resistant bug has appeared in other parts of the world. Last November,
public health officials were horrified when Chinese and British researchers
discovered the colistin-resistent
bacteria in pigs, raw pork meat, and even some humans in China. The deadly superbug
has since been spotted in Africa, Europe, South America, and Canada.

In a study about the Pennsylvanian’s case published Thursday
in Antimicrobial Agents and Chemotherapy,
Defense
Department researchers wrote that the discovery “heralds the emergence of a
truly pan-drug resistant bacteria.”

The so-called “superbug”
kills up to 50 percent of those infected, according to the CDC.

A DIRE warning from the CDC & Dept. of Defense. An infection just detected in a patient in the US is resistant to every antibiotic #CNN

It is an alarming development and U.S. public health
officials fear it signals “the end of the road” for antibiotics as we know
them. “We may be in a situation,” Frieden posited, “where we have patients in
our intensive-care units, or patients getting urinary tract infections for
which we do
not have antibiotics.”

This is a bleak prospect for Frieden who has seen what
happens when there are few treatment options available to patients. “I’ve been
there for TB patients,” he said. “I’ve cared for patients for whom there are no
drugs left. It is a feeling of such horror and helplessness. This is not where
we need to be.”

Pennsylvania Gov. Tom Wolf released a statement addressing
the case
of CRE infection in his state. “We are taking the emergence of this resistance
gene very seriously,” he said. He assured the public that his administration
was working closely with the CDC and Department of Defense on organizing “an
appropriate and collaborative response.” Wolf added that officials were willing
to undergo any measures necessary to prevent the superbug from spreading, a
problem with “potentially serious consequences.”

The antibiotic-resistant gene in CRE can be transferred from
bacteria to bacteria, infectious disease experts say. It has been discovered in
livestock for the most part but it can and has appeared in humans too.
According to Yohei Doi, an infectious disease doctor at the University of
Pittsburgh, the gene is likely moving between livestock and people through
food. “Food handlers may be at higher risk,” Doi says.

This can prove an exceptional risk in places like China
where live animals are sold in close proximity to food stalls and CRE can spread
easily between the two. In the United States, however, it is a different story,
Doi said. American food is sealed in plastic packaging and containers. “These
are the reasons why I don’t think we need to panic,” he said. Still, Doi is concerned
about CRE’s
appearance within North America. “It does tell us that this concerning gene
is in the United States,” he said, “and we need to find out what the extent of
the problem.”

Public health officials are not surprised to find a CRE case
in the United States and they have, in fact, been preparing for it. Yet there
is still no answer to the dwindling effectiveness of antibiotics.

As resistant bacteria spread, doctors are limited in their
treatment options. Small infections can become deadly, routine operations
life-threatening, and pneumonia impossible to treat. Researchers are looking
for an answer to these so-called superbugs as they appear in more patients
across the world.

David Hyun, a senior officer leading an antibiotic-resistance
project at the Pew Charitable Trust, found the Pennsylvania woman’s case “alarming.”
“The fact that we found it in the United States confirms our suspicions,” the
researcher told The Post, “and adds
urgency to actions we need to work on antibiotic stewardship and surveillance for
this type of resistance.”